Prep Initial Interview Form 2016

Pacific Pines Primary School Preparatory Year Initial Interview Form

The information you provide on this form will help us to get to know your child better and will enable us to plan for his/her individual needs. Please comment in the spaces provided.

Child’s Name: ……………………………………………………………………….. Date of Birth: ……………………………..….…………

Preferred Name: …………………………………………….………… Child’s place in family: …………………………………………..…

The following information will help us cater for your child’s needs in Prep in 2016:

1. Does your child attend (or attended) any form of childcare?

attended a local or community kindergarten? attended a pre Prep Provider such as Daycare been cared for solely in the home environment currently attends or has attended an SEDU other …………………………………………………………………………………….………………………………….………….

Hours per week …………………………………………. Years attended ……………………………………………………………..

2. Does your family speak a language other than English at home? Yes / No If so, which language? ………………………………………………………………………………………. 3. Does your family have any cultural or religious practices which may impact on the Prep programme? Yes / No 4. Please indicate if your child’s 4year old health checks have been completed. Yes / No Were there any concerns raised? (Please provide documentation – red book)

Personal Information:

5. Does your child have any allergies (food, insects, medications, etc.) Yes / No If so, what are they? ………………………………………………………………………………………….. 6. Does your child have any intellectual or physical impairment: Yes / No 7. Does your child have a speech delay? Yes / No 8. Does your child attend a speech therapist? Yes / No 9. Do you access any other community services (eg nurse/DAT)? Yes / No

………………………………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………………………………… 10. Do any areas of your child’s development concern you? (e.g. late milestones, Difficult pregnancy or birth, fears, security toys or habits such as thumb sucking?)

Comments: ………………………………………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………………………………………

Physical Health and Well Being:

11. Can your child attend to personal hygiene ( eg toilet, washing/drying hands)? Yes / No 12. Is your child self-managed? (eating lunch, shoe laces, responsible for own belongings, capable Yes / No of making his/her needs known) 13. Does your child take a rest in the afternoons? Yes / No

Social and Emotional Development

14. Does your child follow rules and instructions without reminders? Yes / No 15. Does your child adjust easily to changes in routines? Yes / No 16. Does your child demonstrate self-control? Yes / No 17. Does your child ever act aggressively eg hitting, biting,yelling? Yes / No 18. Can your child solve most everyday problems as they arise? Yes / No 19. Does your child have any separation issues? Yes / No 20. How do you think your child will settle into Prep?

D:\Docs\2017-07-20\065d574ca7dbe1bdc6b14e45d763b893.doc Language and Cognitive Skills

21. Is your child’s speech clearly understood? Yes / No 22. Can your child speak confidently to an adult/child? Yes / No 23. Does your child have access to a computer/internet? Yes / No 24. Can your child use a computer/ipad/tablet independently? Yes / No 25. Does your child recognise his/her name? Yes / No 26. How often do you share a book with your child? Please circle.

Daily Sometimes Weekly Never

27. Does your child enjoy listening to stories? Yes / No 28 Will your child remain attentive while being read to? Yes / No 29. What types of books does your child enjoy?

………………………………………………………………………………………………………………………………………… …

30. Please list areas /learning that your child is interested in?

………………………………………………………………………………………………………………………………………… …… ………………………………………………………………………………………………………………………………… ……………

31. Is your child: Right handed Left handed Undecided

32. Can your child count objects to 10? Yes / No 33. Do they recognise shapes? Yes / No 34. Can they sort and classify objects? Yes / No

General

35. As part of our Partnerships program, we involve parents in the Prep classroom. Will you be available to participate in our parent roster? Yes / No

Comments:

………………………………………………………………………………………………………………………… ……… ………………………………………………………………………………………………………………… ………………

36. Will you be able to bring your child to the school in Term 4 at a negotiated time for pre-assessment in Literacy and Numeracy? Yes / No 37. This school will be organising some sessions in Term 4, mostly covering Literacy. Will you be able to attend these sessions? Yes / No

Drop Off and Pick Up arrangements for your child:

What arrangements have you made for bringing and collecting your child from Prep?

…………………………………………………………………………………………………………………………………………………

Thank you for taking the time to complete this form.

D:\Docs\2017-07-20\065d574ca7dbe1bdc6b14e45d763b893.doc D:\Docs\2017-07-20\065d574ca7dbe1bdc6b14e45d763b893.doc